Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00257189 Renewal 12/19/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.151(c)(4)A staff person who comes into direct contact with individuals shall have a physical exam with in 12 months prior to employment and every 2 years after. The exam shall include any medical problems which might interfere with the health of the individuals. Staff #2 physical exam dated 2/27/24 did document if staff had any medical concerns or not that could interfere with the individuals. Staff #3 physical exam dated 4/23/24 did document if staff had any medical concerns or not that could interfere with the individuals.The physical examination shall include: Information of medical problems which might interfere with the health of the individuals.BroMack Administration reviewed this regulation and all then all staff physicals. It was identified that BroMack¿s Physical Form contains the necessary Physician¿s Statement, however it is not consistent when staff are using their Physician¿s Physical Form. This was the case in this violation. Staff #2 and #3 contacted their physician for updated statements. 12/20/2024 Implemented
6400.211(b)(1)Individual #1 emergency information did not have documentation to reflect the name, address, telephone number and relationship of his emergency contact.Emergency information for each individual shall include the following: The name, address, telephone number and relationship of a designated person to be contacted in case of an emergency. BroMack Administration reviewed the regulation and edited Individual #1¿s emergency information to include his emergency contact¿s address. We then reviewed emergency contact information for each of the Individual¿s we serve and edited emergency contact information to include the address for the each. All required information is now listed. 12/20/2024 Implemented
6400.211(b)(3)Individual's emergency information did not have documentation to reflect the name, address, telephone number and relationship of the person able to give consent for emergency medical treatment.Emergency information for each individual shall include the following: The name, address and telephone number of the person able to give consent for emergency medical treatment, if applicable. BroMack Administration reviewed the regulation and edited Individual #1¿s emergency information to include Consent of Care Information. We then reviewed emergency contact information for each of the Individual¿s we serve and edited emergency contact information to include the Consent of Care Information for the each. All required information is now listed. 12/20/2024 Implemented
6400.50(a)Staff #1 did not have the proper record of her annual training in person centered practices, community integration, individual choice, and supporting individuals to develop and maintain relationships. The training record shall include the training source, content, dates, length of training, copies of certificates shall be kept.Records of orientation and training, including the training source, content, dates, length of training, copies of certificates received and staff persons attending, shall be kept.BroMack Training Staff reviewed the regulation and violation. Staff #1 signed the Person-Centered Training Sheet that was missing her signature. 12/20/2024 Implemented
SIN-00235698 Renewal 12/12/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.112(c)The fire drill conducted on 5/15/23 did not include whether the fire alarm or smoke detector was operable.A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, problems encountered and whether the fire alarm or smoke detector was operative. The staff member responsible for not completing all aspects of the fire drill correctly was retrained by our Fire Safety Trainer on 12/18/2023. Additionally, all staff were retrained 12/26/2023 on the importance of completing fire drills with fidelity and trained on the new Fire Drill Form. 12/26/2023 Implemented
SIN-00216040 Renewal 12/12/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.68(b)At time of inspection the water temperature in the upstairs bathroom was 124.4. Hot water may not exceed 120. Hot water temperatures in bathtubs and showers may not exceed 120°F. BroMack adjusted the water temp while the inspector was onsite. We have since tested the temp and the temp is now 112 degrees. We have video evidence to provide. We test water temps every week at each of our residences and our documentation shows that we were in compliance. However, it was discovered that our method of testing at Oak Terrace was the cause of our inaccurate readings. The Supervisor there was testing the water in a cup rather than under a running stream. This was allowing heat to escape and give an inaccurate reading. We will host a training to review appropriate process. 12/22/2022 Implemented
SIN-00201082 Renewal 03/11/2022 Compliant - Finalized